Multiple Sclerosis
forced to stop these activities due to her MS, her lifestyle had been severely curtailed. Six years previously she could manage to walk four blocks, but now she could only manage two and that would take 40 minutes. Another couple told a similar story. The husband, who was 71 years of age, had been diagnosed with MS 38 years earlier and had been confined to a wheelchair for 20 years. He and his wife, who was his care-giver, had previously enjoyed dancing and family activities, but these had gradually stopped due to his progressive MS. On one occasion while alone in the house, the man had slipped from his wheelchair and had to crawl on his elbows and stomach down his hallway to reach the telephone to get help; it had taken him two hours to cover the short distance. Both couples reported declining social activity and increasing isolation, largely resulting from decreased walking ability and mobility.
The value of improved monitoring and support in MS patient mobility is also illustrated in a report of a 40-year-old man who had a 10-year history of MS.24
He increasingly relied on a wheelchair for
mobility, but was too weak to propel it outdoors. He had decreasing levels of endurance and this severely restricted his walking ability. He was concerned about his inability to go outside and was becoming isolated. He was hospitalised with ataxia and increasing tremors that resulted from his efforts to move about. In the hospital, his mobility needs were assessed and a treatment plan was formulated. He was allocated a powered wheelchair with tremor-dampening electronics and postural and wrist support. He was also given physical therapy that aimed to increase endurance, stretching, strength and sitting balance. These measures substantially improved his life and functional status.
Assessment of mobility in MS is therefore important for an individual patient both at the time of diagnosis and during the course of the disease, and provision of lifestyle interventions associated with recognition of an individual’s mobility status can provide significant benefits. Addressing individual needs, such as providing assistance and physiotherapy or appropriate equipment, enables patients to be less dependent and more able to cope as their disease progresses. This is an important contribution to the life of any individual MS patient and should not be overlooked when considering management strategies. However, such interventions require extensive resources
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2. 3.
Confavreux C, Vukusic S, Age at disability milestones in multiple sclerosis, Brain, 2006;129:595–605.
Confavreux C, Vukusic S, Adeleine P, Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process, Brain, 2003; 126:770–82.
4. Confavreux C, Vukusic S, Accumulation of irreversible disability in multiple sclerosis: from epidemiology to treatment, Clin Neurol Neurosurg, 2006;108:327–32.
5. Kesselring J, Comi G, Thompson A (eds), Multiple Sclerosis – Recovery of Function and Neurohabilitation, Cambridge, UK: Cambridge University Press, 2010.
6. Kesselring J, Beer S, Symptomatic therapy and neurorehabilitation in multiple sclerosis, Lancet Neurol, 2005;4:643–52.
7. Rudick R, Mechanisms of disability progression in primary progressive multiple sclerosis: are they different from secondary progressive multiple sclerosis?, Mult Scler, 2003;9:210–12.
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and are expensive; consequently, many healthcare organisations are currently unable to provide them.
Future Developments in Mobility Assessment and Management in Multiple Sclerosis In the coming years, the importance of impaired mobility in MS will be increasingly recognised and is likely to be monitored more closely by neurologists. Currently, data assessing the impact of mobility impairment in MS are limited both in scope and in the numbers of patients involved. As a consequence, walking ability, which is the most significant aspect of overall mobility, is an insufficiently monitored aspect of the impact of MS. In fact, as in many other diseases, we are only just beginning to recognise the difference between what patients and clinicians consider important. Studies in larger populations of MS patients using general purpose and more specific methods for assessing mobility will contribute to a better understanding of the clinical meaningfulness of mobility data in MS. Data from these studies are likely to result in recommendations and guidelines that specify this faculty be more accurately assessed as part of both the diagnostic process and continuous monitoring throughout the disease course.
Awareness of walking and mobility impairment as a particularly serious consequence of MS, in terms of its contribution to decreased capacity for employment and normal day-to-day functioning, is likely to increase among neurologists, general physicians, patients and care-givers. Demand for more intensive mobility assessment may therefore increase, and continued monitoring throughout the course of MS may allow findings to be used to better assess patient needs.
Increasing recognition of impaired mobility by physicians as a major factor in MS will drive interventions to address patients’ needs and significantly improve many aspects of patients’ lives. It will also encourage the development and use of treatments that improve neurological function, in turn contributing to the achievement of greater independence for patients, increasing their confidence and improving their self-efficacy and overall wellbeing for more extended time periods than would be possible without such interventions. n
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Sutliff MH, Contribution of impaired mobility to patient burden in multiple sclerosis, Curr Med Res Opin, 2010;26: 109–19.
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Rizzo MA, Hadjimichael OC, Preiningerova J, et al., Prevalence and treatment of spasticity reported by multiple sclerosis patients, Mult Scler, 2004;10:589–95.
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